Objective:To investigate the clinical efficacy of laparoscopic hiatal hernia repair (LHHR) combined with Nissen, Toupet, or Dor fundoplication.Methods:The retrospective cohort study was conducted. The clinical data of 102 hiatal hernia patients who were admitted to 4 hospitals including Gansu Provincial Central Hospital from January 2019 to December 2023 were collected. There were 46 males and 56 females, aged (54±4)years. Among the 102 patients, 37 cases who underwent LHHR combined with Nissen fundoplication were assigned to the Nissen group, 34 cases who underwent LHHR combined with Toupet fundoplication were assigned to the Toupet group, and 31 cases who underwent LHHR combined with Dor fundoplication were assigned to the Dor group. Observation indicators: (1) surgical conditions and postoperative recovery; (2) dysphagia before and after surgery; (3) gastroesophageal reflux disease questionnaire (GERD-Q) scores before and after surgery. One-way analysis of variance (ANOVA) was used for comparison of measurement data with normal distribution among groups. In ANOVA, if there were statistically significant differences among groups, the least significant difference (LSD) method was further used for pairwise compari-son. Repeated-measures ANOVA was applied for comparison of repeated measure-ment data. Comparison of count data among multiple groups was conducetd using the chi-square test or Fisher exact probability, and the Dunn-Bonferroni correction was used for further pairwise comparison. Comparison of ranked data between groups was conducted using the Kruskal-Wallis H test. Results:(1) Surgical conditions and postoperative recovery. There was no significant difference in operation time, volume of intraoperative blood loss, time to postoperative first flatus, length of hospital stay, or the incidence of postoperative in-hospital dysphagia, abdominal distension, abdominal pain, diarrhea among the three groups ( P>0.05). At 12 months after surgery, there was no hernia recurrence in the Nissen group, 1 case of recurrence in the Toupet group, and 1 case of recurrence in the Dor group, showing no significant difference among the three groups ( P>0.05). (2) Dysphagia before and after surgery. Before surgery, there was no significant difference in the incidence of dysphagia among the three groups ( P>0.05). At 1 month after surgery, the number of patients with dysphagia in the Nissen group, Toupet group, and Dor group was 20, 18, and 7, respectively, showing a significant difference among the three groups ( χ2=8.39, P<0.05). There was no significant difference between the Nissen group and Toupet group ( P>0.05). There was a significant difference between the Nissen group and Dor group, between the Toupet group and Dor group ( χ2=6.98, 6.32, P<0.05). However, at 6 and 12 months after surgery, there was no significant difference in the incidence of dysphagia among the three groups ( P>0.05). (3) GERD-Q scores before and after surgery. The GERD-Q scores before surgery, at 1 month and 6 months after surgery were 10.8±1.9, 8.5±2.1, 7.1±1.9 of the Nissen group, 11.0±1.6, 8.6±1.9, and 7.1±1.7 of the Toupet group, 10.7±1.6, 8.7±1.9, 7.2±1.8 of the Dor group, respectively. For the GERD-Q scores of the three groups before and after surgery, there was a significant difference in the time effect ( F=104.17, P<0.05), while no significant difference was found in the inter-group effect and interaction effect ( F=0.13, 0.16, P>0.05). Intra-group comparison of GERD-Q scores in the three groups before surgery, at 1 month and 6 months after surgery showed significant differences respectively ( F=38.37, 40.29, 27.20, P<0.05). Conclusions:LHHR combined with Nissen, Toupet, or Dor fundoplication is safe and effective in the treatment of hiatal hernia , which can achieve good anti-reflux effects. The Dor fundoplication is associated with a lower short-term incidence of postoperative dysphagia.

Objective:To investigate the clinical efficacy of laparoscopic hiatal hernia repair (LHHR) combined with Nissen, Toupet, or Dor fundoplication.Methods:The retrospective cohort study was conducted. The clinical data of 102 hiatal hernia patients who were admitted to 4 hospitals including Gansu Provincial Central Hospital from January 2019 to December 2023 were collected. There were 46 males and 56 females, aged (54±4)years. Among the 102 patients, 37 cases who underwent LHHR combined with Nissen fundoplication were assigned to the Nissen group, 34 cases who underwent LHHR combined with Toupet fundoplication were assigned to the Toupet group, and 31 cases who underwent LHHR combined with Dor fundoplication were assigned to the Dor group. Observation indicators: (1) surgical conditions and postoperative recovery; (2) dysphagia before and after surgery; (3) gastroesophageal reflux disease questionnaire (GERD-Q) scores before and after surgery. One-way analysis of variance (ANOVA) was used for comparison of measurement data with normal distribution among groups. In ANOVA, if there were statistically significant differences among groups, the least significant difference (LSD) method was further used for pairwise compari-son. Repeated-measures ANOVA was applied for comparison of repeated measure-ment data. Comparison of count data among multiple groups was conducetd using the chi-square test or Fisher exact probability, and the Dunn-Bonferroni correction was used for further pairwise comparison. Comparison of ranked data between groups was conducted using the Kruskal-Wallis H test. Results:(1) Surgical conditions and postoperative recovery. There was no significant difference in operation time, volume of intraoperative blood loss, time to postoperative first flatus, length of hospital stay, or the incidence of postoperative in-hospital dysphagia, abdominal distension, abdominal pain, diarrhea among the three groups ( P>0.05). At 12 months after surgery, there was no hernia recurrence in the Nissen group, 1 case of recurrence in the Toupet group, and 1 case of recurrence in the Dor group, showing no significant difference among the three groups ( P>0.05). (2) Dysphagia before and after surgery. Before surgery, there was no significant difference in the incidence of dysphagia among the three groups ( P>0.05). At 1 month after surgery, the number of patients with dysphagia in the Nissen group, Toupet group, and Dor group was 20, 18, and 7, respectively, showing a significant difference among the three groups ( χ2=8.39, P<0.05). There was no significant difference between the Nissen group and Toupet group ( P>0.05). There was a significant difference between the Nissen group and Dor group, between the Toupet group and Dor group ( χ2=6.98, 6.32, P<0.05). However, at 6 and 12 months after surgery, there was no significant difference in the incidence of dysphagia among the three groups ( P>0.05). (3) GERD-Q scores before and after surgery. The GERD-Q scores before surgery, at 1 month and 6 months after surgery were 10.8±1.9, 8.5±2.1, 7.1±1.9 of the Nissen group, 11.0±1.6, 8.6±1.9, and 7.1±1.7 of the Toupet group, 10.7±1.6, 8.7±1.9, 7.2±1.8 of the Dor group, respectively. For the GERD-Q scores of the three groups before and after surgery, there was a significant difference in the time effect ( F=104.17, P<0.05), while no significant difference was found in the inter-group effect and interaction effect ( F=0.13, 0.16, P>0.05). Intra-group comparison of GERD-Q scores in the three groups before surgery, at 1 month and 6 months after surgery showed significant differences respectively ( F=38.37, 40.29, 27.20, P<0.05). Conclusions:LHHR combined with Nissen, Toupet, or Dor fundoplication is safe and effective in the treatment of hiatal hernia , which can achieve good anti-reflux effects. The Dor fundoplication is associated with a lower short-term incidence of postoperative dysphagia.

Objective To understand the cognition status of high-alert medications among medical staffs in Chongming District of Shanghai,and to explore its influencing factors and improvement countermeasures,so as to provide references for safe clinical use and effective control of such drugs.Methods Convenient sampling method was used to investigate among medical staffs in 9 hospitals in Chongming District from March to May 2022,the survey content included general information of medical staff and their awareness of high-alert medications.The orderly multi-classification logistic regression was used to analyze the influencing factors of the cognition of high-alert medications among medical staffs.Results A total of 605 valid questionnaires were collected,including 263 from doctors and 342 from nurses.The results of univariate analysis showed that there were significant differences in the grade distribution of high-alert medications management knowledge scores among doctors of different gender,education background and whether to partcipate in in-hospital training(P＜0.05).There were significant differences in the grade distribution of high-alert medications management knowledge scores among nurses with different education background,hospital level and whether to partcipate in in-hospital training(P＜0.05).There was significant differences in the grade distribution of high-alert medications pharmacy knowledge scores whether doctors participated in in-hospital training(P＜0.05).There were significant differences in the grade distribution of high-alert medications pharmacy knowledge scores among nurses with different education background,professional title,working years and whether to partcipate in in-hospital training(P＜0.05).The results of multi-factor Logistic analysis showed that whether doctors had participated in in-hospital training was an influential factor for and high-alert medications management knowledge score level(OR=0.003,95％CI 0.000 to 0.023,P＜0.001),high-alert medications pharmacy knowledge score level(OR=0.252,95％CI 0.147 to 0.431,P＜0.001).Whether nurses participated in in-hospital training(OR=0.022,95％CI 0.010 to 0.048,P＜0.001)and hospital level(OR=3.353,95％CI 1.639 to 6.855,P=0.001)were the influencing factors of nurses'high-alert medications management knowledge score level,and education background(OR=4.933,95％CI 1.452 to 16.760,P=0.011)and whether nurses participated in in-hospital training(OR=0.414,95％CI 0.239 to 0.717,P=0.002)were the influencing factors of nurses'high-alert medications pharmacy knowledge score level.Conclusion The cognition of high-alert medications among medical staffs in Chongming District is at a medium level on the whole.It is suggested to improve their cognitive ability and risk prevention awareness by improving their education,strengthening the knowledge education and training of high-alert medications,and homogenizing management,so as to ensure the safety of clinical drugs.

Objective:To investigated the relationship between magnetic resonance imaging(MRI)parameters and the molecular pathology of primary central nervous system lymphoma(PCNSL).Methods:We retrospectively analyzed 26 patients from The First Affiliated Hospital of Harbin Medical University between January 2020 and June 2023 classified into germinal center B-cell like(GCB)and non-germinal center B-cell like(non-GCB)groups based on cell origin,into Ki-67≥75%and<75%groups based on the Ki-67 index,into BCL-2+and BCL-2-groups based on BCL-2 expression,and into responsive and non-responsive groups based on their response to MAP+Bruton's tyrosine kinase inhib-itor(BTKi)treatment.We extracted and compared first-order parameters between the groups,including mean value,standard deviation,variance,coefficient of variation,skewness,kurtosis,and entropy from baseline MRI images.Results:Four parameters(variance,kurtosis,skewness,and coefficient of variation)showed no significant differences between groups.However,three parameters(mean,standard devi-ation,and entropy)significantly differed between the groups based on Ki-67 and BCL-2 expression.For the Ki-67 index,the three parameters'areas under the curve(AUC)were 0.731,0.831,and 0.913,respectively.For BCL-2 expression,the mean and standard deviation AUCs were 0.889 and 0.938,respectively.In addition,the mean and entropy parameters significantly differed between the groups categorized by cell origin and treatment responsiveness(P<0.05).Multi-parameter joint analysis demonstrated greater identification accuracy compared to util-izing individual quantitative parameters from texture analysis.Conclusions:The mean,standard deviation,and entropy MRI parameters can help predict Ki-67 and BCL-2 expression in patients with PCNSL and have evaluative functions for treatment.They are beneficial for preoper-ative non-invasive assessment of tumor malignancy,providing vidence for prognosis and treatment planning.

Objective To verify the genetic characteristics associated with gastric cancer,and to propose a hybrid feature selection method for identifying target genes,further analyzing their significance and establishing a new diagnostic prediction model.Methods Analysis of variance in bioinformatics was performed on the original gastric cancer data,and then machine learning methods such as random forest,recursive feature elimination of support vector machine,and LASSO algorithm were used to screen gastric cancer associated genes,and the intersection of results was taken as the key gene set.The key genes were identified and verified through enrichment analysis.The diagnosis and prediction models based on 8 kinds of machine learning classification algorithms such as multi-layer perceptron,logistic regression and decision tree,were constructed using the key genes.Results The key genes selected by the hybrid feature selection method were closely related to the tumorigenesis and development.Eight key genes(TXNDC5,BMP8A,ONECUT2,COL10A1,JCHAIN,INHBA,LCTL and TRIM59)were identified as potential markers of good diagnostic efficacy in gastric cancer.The ROC curve and accuracy results demonstrated that among the 8 classification models,MLP is the best gastric cancer prediction model,with an accuracy of 97.77%,which was 3.83%higher than that of Xgboost gastric cancer prediction model.Conclusion The study identifies 8 key genes for the diagnosis and prevention of gastric cancer,and establishes the optimal prognosis model.

Tumors are serious diseases threatening human health,and the early diagnosis is essential to improve treatment success and patient survival.The study of tumor gene expression data has become a major tool for revealing tumor disease mechanisms,in which artificial intelligence plays an important role.The potential advantages of supervised learning,unsupervised learning and deep learning in tumor prediction and classification are explored from the perspective of machine learning methods.Special attention is paid to the impact of feature selection algorithms on gene screening and their importance in high-dimensional gene expression data.By providing a comprehensive overview of the application and development of artificial intelligence in the analysis of tumor gene expression data,the study aims to provide an outlook for future research directions and promote further development.

The hydrolysis of xylo-oligosaccharides catalyzed by β-xylosidase plays an important role in the degradation of lignocellulose. However, the enzyme is easily inhibited by its catalytic product xylose, which severely limits its application. Based on molecular docking, this paper studied the xylose affinity of Aspergillus niger β-xylosidase An-xyl, which was significantly differentially expressed in the fermentation medium of tea stalks, through cloning, expression and characterization. The synergistic degradation effect of this enzyme and cellulase on lignocellulose in tea stems was investigated. Molecular docking showed that the affinity of An-xyl to xylose was lower than that of Aspergillus oryzae β-xylosidase with poor xylose tolerance. The K_i value of xylose inhibition constant of recombinant-expressed An-xyl was 433.2 mmol/L, higher than that of most β-xylosidases of the GH3 family. The K_m and V_max towards pNPX were 3.6 mmol/L and 10 000 μmol/(min·mL), respectively. The optimum temperature of An-xyl was 65 ℃, the optimum pH was 4.0, 61% of the An-xyl activity could be retained upon treatment at 65 ℃ for 300 min, and 80% of the An-xyl activity could be retained upon treatment at pH 2.0-8.0 for 24 h. The hydrolysis of tea stem by An-xyl and cellulase produced 19.3% and 38.6% higher reducing sugar content at 2 h and 4 h, respectively, than that of using cellulase alone. This study showed that the An-xyl mined from differential expression exhibited high xylose tolerance and higher catalytic activity and stability, and could hydrolyze tea stem lignocellulose synergistically, which enriched the resource of β-xylosidase with high xylose tolerance, thus may facilitate the advanced experimental research and its application.
Aspergillus niger/genetics* ; Xylose/metabolism* ; Molecular Docking Simulation ; Xylosidases/genetics* ; Cellulases ; Tea ; Hydrogen-Ion Concentration ; Substrate Specificity

OBJECTIVE: To propose a framework that combines sinogram interpolation with unsupervised image-to-image translation (UNIT) network to correct metal artifacts in CT images. METHODS: The initially corrected CT image and the prior image without artifacts, which were considered as different elements in two different domains, were input into the image transformation network to obtain the corrected image. Verification experiments were carried out to assess the effectiveness of the proposed method using the simulation data, and PSNR and SSIM were calculated for quantitative evaluation of the performance of the method. RESULTS: The experiment using the simulation data showed that the proposed method achieved better results for improving image quality as compared with other methods, and the corrected images preserved more details and structures. Compared with ADN algorithm, the proposed algorithm improved the PSNR and SSIM by 2.4449 and 0.0023 when the metal was small, by 5.9942 and 8.8388 for images with large metals, and by 8.8388 and 0.0130 when both small and large metals were present, respectively. CONCLUSION The proposed method for metal artifact correction can effectively remove metal artifacts, improve image quality, and preserve more details and structures on CT images.
Artifacts ; Algorithms ; Computer Simulation ; Tomography, X-Ray Computed

Scopoletin is a coumarin compound with various biological activities including detumescence and analgesic, insecticidal, antibacterial and acaricidal effects. However, interference with scopolin and other components often leads to difficulties in purification of scopoletin with low extraction rates from plant resource. In this paper, heterologous expression of the gene encoding β-glucosidase An-bgl3 derived from Aspergillus niger were carried out. The expression product was purified and characterized with further structure-activity relationship between it and β-glucosidase analyzed. Subsequently, its ability for transforming scopolin from plant extract was studied. The results showed that the specific activity of the purified β-glucosidase An-bgl3 was 15.22 IU/mg, the apparent molecular weight was about 120 kDa. The optimum reaction temperature and pH were 55 ℃ and 4.0, respectively. Moreover, 10 mmol/L metal ions Fe²⁺ and Mn²⁺ increased the enzyme activity by 1.74-fold and 1.20-fold, respectively. A 10 mmol/L solution containing Tween-20, Tween-80 and Triton X-100 all inhibited the enzyme activity by 30%. The enzyme showed affinity towards scopolin and tolerated 10% methanol and 10% ethanol solution, respectively. The enzyme specifically hydrolyzed scopolin into scopoletin from the extract of Erycibe obtusifolia Benth with a 47.8% increase of scopoletin. This demonstrated that the β-glucosidase An-bgl3 from A. niger shows specificity on scopolin with good activities, thus providing an alternative method for increasing the extraction efficiency of scopoletin from plant material.
Aspergillus niger/genetics* ; beta-Glucosidase/chemistry* ; Scopoletin ; Polysorbates ; Coumarins

Objective:To explore the adherence and its influencing factors of tegafur, gimeracil and oteracil potassium (S-1) treatment in patients with tumor-node-metastasis (TNM) stage Ⅲ gastric cancer after operation.Methods:Medical records of adult patients with stage Ⅲ gastric cancer after operation in the Second Affiliated Hospital of Nanjing University of Chinese Medicine from October 2018 to April 2022 and treated with oral S-1 were collected, and the S-1 adherence and its related factors in these patients were retrospectively analyzed according to their S-1 treatment information. Good adherence was defined as completing 8 cycles of S-1 treatment within 186 days (14 days of continuous medication and 7 days of discontinuation as 1 cycle). The patients were divided into good and poor S-1 adherence groups. Univariate and multivariate logistic regression analysis were performed to analyze the factors affecting S-1 adherence of patients.Results:A total of 148 patients were entered in the study, including 116 males (78.4%) and 32 females (21.6%), with a median age of 67 (27-85) years. Sixty-nine patients (46.6%) completed ≥ 8 cycles of S-1 treatment within the set time and had good adherence; 79 (53.4%) patients had poor adherence. The reasons for interruption or failure to complete treatments as scheduled in the 79 patients were serious adverse reactions in 30 (38.0%) patients, refusal to treat in 27 (34.2%) patients, and poor curative effect in 22 (27.8%) patients. Univariate and multivariate logistic regression analysis showed that lack of or partial understanding of the disease [odds ratio ( OR)=5.368, 95% confidence interval ( CI): 1.488-19.370, P= 0.010; OR=3.393, 95% CI: 1.309-8.793, P=0.012], gastric cancer with a course of less than 1 year ( OR=10.214, 95% CI: 2.400-43.472, P=0.002), and TNM stage Ⅲa ( OR=3.879, 95% CI: 1.522-9.886, P=0.005) were the independent influencing factors of poor adherence to S-1 treatment in patients with gastric cancer. Conclusions:Less than half of the gastric cancer patients with stage Ⅲ after operation had good adherence to S-1 treatment. Insufficient understanding of the disease, short duration of gastric cancer, and TNM stage Ⅲa were independent influencing factors for poor adherence to S-1 treatment in gastric cancer patients. Increasing patients′ understanding of the disease and strengthening patient education may be important strategies to improve S-1 treatment compliance.